Policy changes encourage breast-feeding

Hospitals and insurance companies offer better support to new mothers who choose natural feeding

By Alysia Santo

Published 11:12 pm, Sunday, February 24, 2013

Photo: Cindy Schultz

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Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times Union) less

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times ... more

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times Union) less

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times ... more

Photo: Cindy Schultz

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Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times Union) less

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times ... more

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times Union) less

Chelsea Prisco, maternity coach and consultant, right, with client Devon Votto of Albany and her 5-month-old son Caiden on Friday, Feb. 15, 2013, at Prisco's home in Schenectady, N.Y. (Cindy Schultz / Times ... more

Photo: Cindy Schultz

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Policy changes encourage breast-feeding

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By the time Devon Votto got to hold her first-born child, Thomas, he already had a full belly.

"Without asking," nurses had given Thomas bottled formula immediately after he was delivered by C-section, Votto said. As she left the hospital, she was handed a parting gift: two boxes of Enfamil, a popular brand of infant formula. Hospital staff told her she could come back for more, for free.

"I thought, 'jackpot,'" she said.

A single mom who was already seriously doubting her ability to breast-feed, Votto gladly took the free food. She also continued to purchase Enfamil.

That was 2009. Sponsored by formula companies, made possible by hospitals, this was a typical scenario for decades.

Now that's changing. Bucking the prevailing maternity-ward culture of the past half-century, the movement to return breast-feeding to its place as the norm for infant nourishment has gained ground in recent years.

The health advantages of breast-feeding are not debated. Recently, scientific consensus was backed up with the federal Affordable Care Act, which ensures reimbursement for lactation support services and breast pumps at no extra cost.

More Information

Hospital scorecard

CDC's Maternity Practices in Infant Nutrition and Care (mPINC) survey scores how well hospitals' practices support breast-feeding on a scale of 0 to 100.

National average

2009: 65

2011: 70

New York average

2009: 67

2011: 73

St. Peter's Hospital

2009: 44

2011: 76

Glens Falls Hospital

2009: 67

2011: 74

Bellevue Woman's Center

2009: 70

2011: 80

Saratoga Hospital could not locate survey results in time for publication

Albany Medical Center did not participate in the mPINC survey

At the same time, hospitals voluntarily changed their policies.

Rhode Island and Massachusetts hospitals have agreed to statewide bans on formula giveaways, and hundreds of facilities across the country are implementing the sweeping changes required to earn "Baby-Friendly" designation, a rigorous certification offered by the World Health Organization and UNICEF.

"Changing cultures is a hard thing to do," said Trish MacEnroe, director of Albany-based Baby Friendly USA. "We believe that most of the women who have difficulty and turn to formula simply didn't have the right care and support."

At Vassar, she was told she wasn't producing enough milk and would need to supplement with formula. At St. Peter's, lactation consultants spent significant time with her. There was also no free gift when she left; St. Peter's prohibits formula giveaways.

Despite the proximity of Baby Friendly's headquarters to the Capital Region, no local hospital has yet achieved the designation. All, though, have either formally begun the process or say they intend to. Nationwide, there are 156 designated hospitals and about 600 working toward it; so far four New York hospitals have achieved the designation. In 2009, there were some 80 Baby-Friendly hospitals and 70 working towards designation.

Baby Friendly requires hospitals implement 10 steps, including "skin to skin" contact between mother and baby within the first hour of birth and "rooming in," keeping infants overnight in the mother's room. Both, studies say, improve success rates for breast-feeding. Every major hospital in the Capital Region has implemented these practices.

Baby Friendly also requires hospitals to stop formula giveaways for moms and babies without specific medical needs, and to no longer accept free or discounted supplies from formula companies, a practice that dates back to at least the 1950s.

Noelle Smassanow, the head lactation consultant at Saratoga Hospital, said the hospital officially stopped giving out formula samples in January, a move that every area hospital also has done.

Besides banning the formula-filled gift bags, local hospitals are looking at ways to begin purchasing formula at "fair market price" rather than receiving it for free, one of the tenets of Baby Friendly.

Glens Falls Hospital is in the process of changing policies, and Ellis Medicine's Bellevue Woman's Center has a pending contract to purchase formula. Burdett Care Center in Troy and St. Peter's made the switch to buying formula.

Those who work the floors of local maternity wards point out that it's a delicate matter.

"You have to find that fine mix of educating and encouraging, but not offending those who choose not" to breast-feed, said Kelly Duheme, a board-certified lactation consultant at Burdett Care Center.

"I like to say, 'How are you going to give your breast milk to your baby?' and see where that takes me," said Duheme. "In the end, it's her decision. We very much respect that."

Breast-feeding may be natural, but that doesn't make it effortless.

Votto was distressed by difficulty she had breast-feeding once she got home from delivering her second child. Because a car accident in 2000 had damaged one of her breasts, she depended on her lactation counselor, Chelsea Prisco, founder of Bumps to Blessings, which offers support to new mothers.

Votto's work paid off: At 6 months old, Caiden has only been breast-fed.

Prisco's in the business of home visits, a service her clients are looking for. "It's a chore to pack up your newborn and go to the hospital," said Prisco. "Plus, it's a very germy, sort of the last place you want to bring your brand new baby."

Despite the provisions in the Affordable Care Act that mandate that insurance companies cover lactation consultations, Prisco has been unable to get reimbursed for her services.

The government has yet to issue any guidelines to insurance companies about how to interpret the law, according to Marsha Walker, executive director of the National Alliance for Breastfeeding Advocacy. "Most mothers don't have access to a (lactation consultant) unless they pay for it themselves."

The ACA also requires insurance plans to pay for pricey breast pumps, which can cost several hundred dollars but allow moms to go back to work. This part of the law also is not specific, Walker said, so coverage varies among health plans, and some plans require the child to be born before the pump can be ordered.

"It's one step towards what we need, but a pump that arrives 14 days after delivery does her no good whatsoever," she said.

Still, it's the type of changes Dr. Ruth Lawrence has been advocating for most of her life. She set up a breast-feeding group in Rochester in the early 1950s, and said she wrote the first textbook on breast-feeding in 1979, which is now in its seventh edition. She said well-educated women "led the march to the bottle in the '30s, '40s and '50s" because "she wanted science to rear her child." But things have come full circle, and many women are returning to natural methods of childbirth and child-rearing.

"It took a village working together over a long period of time to get these changes," said Lawrence. "It's the work of all that made a difference."